Perioperative mortality
Death within 30 days of surgery, a key surgical risk measure.
Perioperative mortality refers to any death occurring within 30 days of surgery, regardless of cause or location. It is a key measure in evaluating surgical risk, with an estimated 4.2 million such deaths globally each year. The decision to operate involves weighing potential benefits against this risk, using tools like the ASA score to assess patient condition.
Complications following surgery
Surgical site infections (SSI) are a major complication, with a disproportionately higher burden in low-HDI countries, where antibiotic resistance may also be more common. Sterile technique and prophylactic antibiotics are standard preventive measures, particularly in abdominal surgery or for patients with heart defects or mechanical valves at risk of endocarditis. In spine surgery, antiseptic skin preparation with chlorhexidine gluconate in alcohol is twice as effective as other antiseptics; other methods include judicious drain use, prophylactic antibiotics, and vancomycin. The effect of specific dressings on SSI risk in sutured wounds remains unclear. A Cochrane review found insufficient evidence to support strict perioperative blood glucose control for SSI prevention, calling for more trials. Other complications include deep vein thrombosis and pulmonary embolism, which can be mitigated by anticoagulants, antiplatelet drugs, compression stockings, or cyclical pneumatic calf compression in high-risk patients.
Epidemiology
Most perioperative mortality results from surgical complications such as bleeding, sepsis, or organ failure, or from pre-existing medical conditions. Mandatory reporting of perioperative mortality exists in some high-resource systems but not in most countries, so global figures are estimates. Half of the estimated 4.2 million annual deaths occur in low- and middle-income countries. League tables comparing hospital quality based on perioperative mortality are criticized because mortality may reflect factors like a high proportion of unplanned surgery rather than poor performance. Most hospitals hold regular meetings to review complications and deaths, with closer investigation of preventable cases. A prospective study of 10,745 adults undergoing emergency abdominal surgery across 58 countries found mortality three times higher in low-HDI than high-HDI countries after adjustment for prognostic factors; the 30-day mortality was 4.5% in high-HDI, 6.0% in middle-HDI, and 8.6% in low-HDI countries. A sub-study of 1,409 children from 43 countries found adjusted mortality up to seven times greater in low- and middle-HDI countries, translating to 40 excess deaths per 1000 procedures, with use of the WHO Surgical Safety Checklist associated with reduced 30-day mortality.
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